What does the diagnosis cin mean 1 2. Cervical dysplasia, CIN, SIL

Cervical dysplasia is a disease accompanied by an atypical change in the cells of the epithelium of the cervix.

The diagnosis of "cervical dysplasia" was used in the 80s of the last century. Until 2012, foreign medicine used the term "cervical intraepithelial neoplasia" (Cervical intraepithelial neoplasia, or CIN in English). ICD10 code: N87.

Since 2012, a new term has been introduced in foreign medicine: SIL - squamous intraepithelial lesion. SIL in English: squamous intraepithelial lesion.

This term more clearly reflects the process of changing cells in the cervix, distinct from cancer. If the term neoplasia meant "neoplasm", that is, a tumor. That term "defeat" is precisely the defeat of epithelial cells by a virus, and cancer is still far away.

Let us agree in this article to call this pathology both terms. But gynecologists, I repeat, diagnose CIN.

What it is? Photo.

Dysplasia, or neoplasia of the cervix, is the degeneration of normal cells of the epithelium of the vaginal part of the cervix. Cells become unnatural, cease to perform their function. Such cells look a bit like cancer cells, but are not yet cancerous in their entirety (see photo).

In the photo: normal, dysplasia and cervical cancer

The scheme of development of cervical dysplasia

Remember: dysplasia is not cervical cancer!!! It takes more time for cancer to develop: an average of 10-20 years.

Causes

The main cause of cervical dysplasia, or CIN, is the human papillomavirus, its types are 6, 11, 16, 18, 31, 35, 39, 59, 33, 45, 52, 58, 67. .

According to the latest data from foreign studies, a woman's smoking increases the risk of the virus penetrating the cervical epithelial cells by TIMES.

Occurrence in diseases

• In 73-90% of cases with cervical cancer, HPV types 16, 18 and 45 are found
• In 77-93% of cases with cervical cancer, HPV types 16, 18, 45, 31 and 59 are found
• In 80-94% of cases with cervical cancer, HPV types 16, 18, 45, 31, 33 and 59 are found
• Precancerous conditions in urology and gynecology are often combined with 61, 62, 68, 70, 73 HPV types.
• Worldwide, 500,000 new cases of cervical cancer are diagnosed every year.

Penetrating into the epithelium of the cervix, this virus is embedded in the DNA of cells and disrupts their work. As a result, the cells become unnatural, different in shape and size, do not fulfill their purpose, and in the future can degenerate into cancer.

CIN progression process

Symptoms

There are practically no symptoms of cervical dysplasia (or neoplasia). Most often, a woman has no signs of the disease. And only in rare cases, with a severe degree of dysplasia, the only sign may be slight bloody discharge from the vagina after intercourse.

Classification

The classification of cervical intraepithelial dysplasia is as follows (see also in the photo):

1. cervical dysplasia 1st degree(CIN I, mild): cells affected by 1/3 of the thickness of the entire epithelial layer. Treatment in this case is not required. Only observation. Usually, in 90% of women, the process goes away on its own, without treatment. Mandatory: after 6 months, a re-examination and testing by a gynecologist.
2. cervical dysplasia 2 degrees(CIN II, moderate or moderate): cells affected by 1/3 - 2/3 of the thickness of the epithelial layer. Requires treatment.
3. cervical dysplasia 3 degrees(CIN III, severe): cells are affected by 2/3 - the entire thickness of the epithelial layer. Comprehensive treatment is required.

What do cells look like with dysplasia

New classification (since 2012):

1. LSIL, or Low grade SIL, or mild degree (corresponds to CIN 1 according to the old classification)
2. HSIL, or Hight grade SIL, or severe (corresponds to CIN 2-3 according to the old classification).

Cytologists have adopted the terminology of the Bethesda System, or TBS:

• NILM. This is the norm. In English it means "Negative for intraepithelial lesion or malignancy". That is, "there is no intraepithelial lesion."
• ASC US. There are atypical flat cells of unknown origin. In English: "Atypical squamous cells of undetermined significance".
• ASC-HSIL. There are atypical squamous cells of unknown origin, most likely due to intraepithelial changes.
• LSIL, or Low grade SIL, or mild intraepithelial changes.
• HSIL, or High grade SIL, or severe intraepithelial changes.
• AGS. There are atypical glandular cells of unknown origin. That is, these are cells from the cervical canal.
• AGC, favor neoplastic. There are atypical glandular cells, neoplasia may develop.
• AIS. This is adenocarcinoma in situ, that is, cancer of the cervical canal in situ.

How to establish a diagnosis?

1) Pap test.
Another name is Pap smear. This is a cytological test, or "liquid-based cytology." During a gynecological examination, the doctor holds a special tool on the surface of the cervix, the material is sent for examination under a microscope.

If abnormal cells are detected, then dysplasia occurs, but the degree must also be established. The woman is offered a biopsy.

2) Biopsy of the cervix.
During colposcopy, a microscopic piece is plucked from the cervix in the area of ​​the pathological site with a special device and sent for examination under a microscope.

As a result, the degree of dysplasia (neoplasia) of the epithelium is assessed based on the thickness of the affected layer and the severity of cell damage.

3) Analysis for HPV.
A smear is taken from the surface of the cervix and sent for PCR. If HPV is detected, then their types are determined.

4) Immunohistochemistry with tumor markers.
This analysis is not performed for all women, but only for suspected cervical cancer. If the patient has cancer, then when the tumor proteins bind to special reagents, this analysis becomes positive.

If there is no cervical cancer, then there are no specific tumor proteins (or markers), so the test result will be negative.

Analysis questions

- If I have HPV positive and my partner is negative, how can this be and should I treat my partner?

The main thing: treatment is prescribed only when there are manifestations of the virus on the skin or on the mucous membranes. Or when cytology or biopsy showed neoplasia. In some cases, when planning a pregnancy, both partners should be treated.

Now for the reasons for this discrepancy in the analyses. The main reason: the partner's immunity is strong enough to suppress the virus and prevent it from developing.

- Why does liquid cytology show the presence of dysplasia, but biopsy does not?

Because for liquid cytology, the material is taken from many sections of the mucosa, and for biopsy - from one or two. It is possible that during the biopsy the material was taken from healthy areas.

Brief Infographic on CIN

Treatment of cervical dysplasia

Remember: how, with what and when to treat - only a doctor can answer this question. You can not enter any folk remedies into the vagina, otherwise you will provoke complications.

Principles of treatment depending on the degree of the disease

1) Mild treatment.
It is carried out with general strengthening drugs. That is, drugs are used, including folk remedies that enhance immunity. Specific treatment, according to modern recommendations, does not require a mild degree, since in 90% of cases it resolves itself.

2) Medium treatment.
Necessary drug treatment, although in some cases you can also get by with general strengthening drugs.

A moderate degree is cured on its own in 70% of sick women. If the human papillomavirus is detected in the tests, then treatment should begin immediately.

3) Severe treatment.
Medical treatment is mandatory, otherwise there is a very high risk of neoplasia degenerating into cervical cancer.

The scheme of treatment of cervical dysplasia

Treatment Methods

Therapeutic treatment

1) Topical antiviral drugs - in the form of douches, suppositories, tampons

2) Antivirals general - to suppress the virus in the body as a whole:

• isoprinosine (or groprinosine) -
• allokin-alpha -
• epigen intimate -
• panavir - instructions for use

3) immune preparations (polyoxidonium, roncoleukin, immunal, viferon, geneferon and other interferon preparations).

Surgery

1) electrocoagulation, or electroconization, or loop electroexcision of the cervix. Performed by a gynecologist. A special metal loop under the influence of an electric current affects the epithelium of the cervix.

2) laser vaporization, laser conization of the cervix. The mechanism of action is the same, only a different factor of influence is not an electric current, but a laser.

3) treatment with radio waves on the Surgitron apparatus. The method of exposure is similar to laser, but the main factor is the radio wave.

4) cryodestruction, or cauterization with liquid nitrogen. Thermal destruction of the affected epithelium occurs, it dies off and a new, unaffected epithelium grows in its place.

5) ultrasonic destruction. The mechanism is similar to the action of a radio wave or a laser, only the active factor is ultrasound.

6) conization with a scalpel. Classical operation using a scalpel. Rarely used nowadays as the above methods are more efficient.

7) amputation of the cervix. This is an extended operation. Used in cervical cancer.

Alternative treatment intravaginally

In the vagina, it is generally not recommended to introduce any medicines, except for official pharmaceutical preparations prescribed by a gynecologist. Otherwise, you can get serious complications that the doctor will not be able to deal with later.

Remember:

Self-treatment is unacceptable!!!

Have courage and patience, and go to the doctor!

If you doubt the competence of a doctor, contact another, a third doctor. But do not try to cure cervical dysplasia with home remedies.

We present to your attention an expert opinion on this issue. Watch video:

• what is cervical erosion? How is it different from dysplasia?

Attention: if the doctor did not answer your question, then the answer is already on the pages of the site. Use the search on the site.

Cervical dysplasia - CIN - cervical intraepithelial neoplasia - SIL (squamous intraepithelial lesion) - a precancerous condition. Approximately 10,000 women a year are diagnosed with this disease, and 6,000 patients eventually die from cervical cancer. The reason is the late appeal to the gynecologist, when the well curable stages of CIN1 and CIN2 passed into the intractable CIN3.

Consultation of a gynecologist, urologist - 1000 rubles, consultation on the results of ultrasound, tests - 500 rubles. (optional).

What is cervical dysplasia, causes

Cervical cancer does not start suddenly, it is preceded by 3 precancerous stages of dysplasia, when several layers of cells of the squamous epithelium (lining skin) of the cervix undergo changes. Gradually normal epithelial cells replace atypical - modified. They have a different structure, size and change their location. As a result, the epithelium from a multilayer, easily renewed, is transformed into a single layer.

Determined that main reason dysplasia - human papillomavirus, or rather its oncogenic types - 16 and 18 serotypes, sexually transmitted. At the same time, dysplasia does not start from scratch - it is preceded by, which women often ignore, not wanting to treat. In other words, dysplasia is a complication of erosion. Untreated erosion turns into dysplasia in 90% of cases.

This is due to the fact that the virus freely infects immature germline squamous epithelial cells located in the erosion zone. Such zones are called transformation zones, therefore milestone erosion treatment - processing (closing) of these zones by various methods. In modern clinics, laser and radio techniques are used. After treatment or laser, all affected cells are removed, closing the path for dysplasia

Stages and symptoms of cervical dysplasia: CIN 1, CIN 2, CIN 3 - what is it?

Dysplasia is more common in women over 25 years of age, when immunity is weakened due to a change in sexual partners, which forces the vaginal flora, childbirth and other reasons to constantly rebuild. The peak incidence occurs at 35 years of age. At the same time, the risk of developing cancerous tumor exists after the age of 65. English scientists from the University of Kiel proved that HPV, which entered the body at a young age, may not manifest itself for years and decades, becoming more active after menopause.

The disease is asymptomatic for a long time, being discovered accidentally on .

In rare cases, the following symptoms may appear in the precancer stage:

• vaginal discharge (daub);
• discharge after intercourse;
• intermenstrual bleeding;
• pain in the lower abdomen.

The absence of bright typical signs makes the pathology especially dangerous. Women who neglect .

The stages of dysplasia are abbreviated as CIN. To understand the essence of the process by stages, consider the table.

Dysplasia requires immediate treatment; without it, it easily changes stages, reaching CIN 3, which can already be considered cancer. A more accurate name is local cancer, "cancer in situ", i.e. still on metastasis, which leaves hope for a cure. The first stages of precancer INS 1 and INS 2 are completely curable with proper therapy.

What do the terms CIN and SIL mean?

In medicine, the diagnosis of cervical dysplasia is called differently. To make the interpretation of the diagnosis understandable throughout the world, a unified classification of the stages of the process was introduced. Initially, dysplasia was designated as CIN, which stood for cervical intraepithelial neoplasia. More accessible - the development of a tumor within the epithelial layer.

When SIN turns into cervical cancer, the process takes a different turn - atypical cells grow into the tissues, going beyond the epithelium. Also, the tumor gives metastases, this CIN differs from cancer.

In 2012, WHO introduced a different terminology - CIN was replaced by SIL - squamous intraepithelial lesion - (squamous intraepithelial lesion). The concept of neoplasia has changed to the more objective term "lesion". Only 2 degrees were left - a mild degree of damage - LSIL (Low grade SIL) and a severe degree of damage - HSIL (Hight grade SIL). LSIL is equated to dysplasia 1 (CIN 1), and HSIL to dysplasia 2-3 (CIN 2 and 3). Many specialists still use the first classification, as it more accurately characterizes the scope of the process and allows you to choose the most sparing treatment.

Examination for cervical dysplasia: how to identify CIN 1, CIN 2, CIN 3

Diagnosis of cervical dysplasia throughout the world is carried out according to the standards recommended by the World Health Organization. In Russia in good clinics The following scheme of examination for dysplasia is used:

• Examination by a gynecologist using(examination of the cervix under a gynecological microscope with high magnification).
• - Pap test (taken by the gynecologist during the examination). The smear includes epithelial cells, which are then examined in the laboratory under a microscope. Atypical cells are detected: quantity, quality.
• Biopsy of the cervix. This additional clarifying examination is carried out with poor smears for cytology and colposcopy.
• Blood for tumor markers. If the cancer is already there, it will show in the results.

The first two examinations for syn1, syn2 and syn3 are included in the mandatory prevention program oncological diseases in gynecology. Colposcopy and Pap smear should be done at least every three years, starting at age 25. This program is called -.

Evaluation of Biopsy Results for INS 1, 2, and 3

The diagnosis of dysplasia is made on the presence of atypical cells in a cytology smear and the identified loss of the possibility of normal maturation of stratified squamous epithelium cells due to increased proliferation (accelerated division) of cells.

Dysplasia first degree (LSIL, CIN 1)

With grade 1 dysplasia, HPV invades cells, gradually changing the structure of cells, causing their growth to accelerate. At the same time, this applies not only to erosion, a similar process leads to the formation of genital and flat condylomas. With strong cellular immunity, after removal of genital warts, the process is inhibited. Since papillomavirus invades the genome of cells, it is impossible to cure it, which is why erosion and papillomas are removed by various methods, trying not to leave affected cells.

Dysplasia second - third degree (HSIL, CIN 2-3)

The development of the dysplastic process directly depends on the patient's immunity. And even with treatment started at these stages, the infection remains and progresses in 10% of women, which guarantees the development of cancer. At the same time, the rate of development of the process can be different and reach up to 15 years. For this reason, if a woman has been diagnosed with CIN 1 at least once, she will have to control the condition of the cervix all her life.

Cell changes in stages CIN 2-3 are only neoplastic in nature - i.e. they are completely transformed, and the boundaries of the process are expanding. The number of atypical cells prevails, they multiply rapidly, replacing the normal epithelial layer of the cervical glands and even the canal.

How is cervical dysplasia treated in different stages

How the treatment will be carried out depends on the degree of dysplasia.

For pregnant or nulliparous women, expectant management is possible for CIN 2 and 3, provided the coverage area is small. But the entire period of pregnancy should be regularly tested for cytology and undergo a colposcopic examination.

Where to take tests and cure CIN 1, CIN 2, CIN 3 in St. Petersburg, prices

Treatment of all stages of precancer requires high-quality diagnostics and treatment using professional modern equipment. invites all women - residents and guests of the city to undergo examination and treatment of dysplasia at any stage. Gynecologists of the clinic use new devices - colposcope and radioknife "Fotek" - this the best equipment recommended by the Ministry of Health.

In our medical center, you can take tests, without pain and complications, cure erosion and dysplasia (laser, radioknife). We perform any gynecological low-traumatic operations, for example, conization of the cervix, excision with electric loops.

An appointment with a gynecologist costs only 1000 rubles, an appointment based on the results of tests - 500 rubles. Oncologist's appointment - 1000 rubles. Today it is practically the lowest and most adequate price in St. Petersburg.

Cervical intraepithelial neoplasia (CIN) is defined as a disease of the cervix associated with human papillomavirus infection of sufficiently significant oncogenic risk. This term refers to some changes in the tissues of the cervix of a morphological nature, characterized by signs of intensive, pathological cell reproduction and atypia. Atypia refers to the process of cells losing their normal structure and differentiation due to the penetration of the human papillomavirus into them.

Rice. 1. Cervical cancer

It is characteristic that the life span of a cell changed due to cervical intraepithelial neoplasia is shortened. Most changes occur in the basal and middle layers of the uterine epithelium. Over time, such violations of cellular elements can provoke a tumor of the cervix. It was noted that the stroma and the surface layer of the tissue affected by CIN remain unchanged, and only in the surface layer is it possible to identify mature keratinizing elements.

The danger of cervical dysplasia caused by cervical intraepithelial neoplasia is that, without distinct clinical symptoms, it is difficult to determine during the examination. Guaranteeing an accurate diagnosis is possible only when obtaining data from histological and cytological studies. WHO recommends using a classification that defines three grades for cervical intraepithelial neoplasia.

1. Mild dysplasia (CIN 1). Characteristics: Unexpressed changes in the structure of the epithelium with moderate proliferation of basal cells. Morphological features papillomavirus infection: dyskeratosis and koilocytosis. Changes do not cover more than 1/3 of the thickness of the epithelium, starting from the basement membrane. Such conditions make it difficult to diagnose due to the small depth and volume of material sampling for cytological studies during screening studies.

2. Moderate dysplasia (CIN 2). Characteristics: More pronounced form of morphological changes. Lesions cover half the thickness of the epithelium, starting from the basement membrane.

3. Severe dysplasia (CIN 3). Characteristics: Over two-thirds of the epithelium is affected. There is a distinct manifestation of morphological changes. CIN 3 is characterized by the appearance of pathological mitoses and the presence of multiply enlarged (hyperchromic) cell nuclei.

Cervical intraepithelial neoplasia is typical for women of different age groups, although it prevails in the age category of 25-30 years. It is believed that this is a consequence of the greatest sexual activity in this period and an increased risk of HPV infection.

When infected with cervical intraepithelial neoplasia, various conditions of the cervix are recorded in the mirrors during examination. It can be either minimal or visible to the eye changes, in particular exophytic condyloma or leukoplakia. In the process of colposcopy, colposcopic pictures of an abnormal nature are determined. In cases of visualization of pathological vessels, atypical epithelium (iodine-active zone against the background of transformation zones), zones of atypical transformation (in particular, with signs of epithelialization of the glands), acetowhite epithelium, leukoplakia, it is necessary to conduct targeted biopsy with subsequent histological studies.

It has been established that different stages of cervical dysplasia provoked by cervical intraepithelial neoplasia are a single process of development and malignancy of cervical cancer. However, it should be known that CIN 1 and CIN 2 are reverse processes, as there is evidence that the process may regress during treatment.

CIN 3 is carcinoma in situ - cancer in situ. That is why severe cervical dysplasia is sometimes characterized as the absence of differentiation of the cellular element throughout the thickness of the epithelium, however, without invasive signs (expansion of the process beyond the basement membrane).

Today, there are three treatment options for cervical intraepithelial neoplasia: immediate treatment, active treatment, and the expectant management option.

Elena 2019-09-21 09:44:33

Good afternoon Please tell me, I passed onco markers - liquid cystology, colposcopy. everything is normal, but bleeding has opened, they took a histology - In a scanty blood scraping, small fragments of endometrial adenocarcinoma with focal squamous metaplasia; separate focus of metaplastic MPNOE CIN1

Good afternoon. Please clarify your question. With such a histological picture, you need to consult an oncogynecologist. Thank you.

Marina 2019-06-11 16:31:57

Hello. They did the conization. Histological results: Focal squamous intraepithelial neoplasia of a high degree (syn 3) coagulation line at a distance of 2.5 mm with ingrowth into the cervical glands against the background of leukoplakia. What does it mean? Cancer? What to expect? Thanks for the answer. While the doctor deciphers at the meeting, I will die from guesswork (

Korobkova Elena Vladimirovna Obstetrician-gynecologist answers:

Good afternoon. You have changes in the epithelium of a high risk of developing cancer. Obligatory supervision at the doctor and performance of all instructions is necessary. Before a doctor's appointment, use the Panavir Intim spray to increase local immunity. Thank you.

Valentine 2019-02-18 11:21:33

I was diagnosed with syn3 with a suspicion of cancer. They send him for a biopsy, claiming that it is also a treatment. It costs 10 thousand rubles.

Marina 2019-01-22 07:12:45

Answer, please, according to the results of the analyzes, it is written: epidermization of cervical ectopia on the surface with a tendency of the epithelium to grow in depth with focal dysplasia of 2-3 degrees. Leukoplakia. What does this mean? HPV is negative.

Marina 2019-01-18 07:24:50

according to the results of the analyzes, it is written: epidermization of cervical ectopia on the surface with a tendency of the epithelium to grow in depth with focal dysplasia of 2-3 degrees. Leukoplakia. What does this mean?

Elena 2019-01-04 20:46:12

In the sent biopath, pieces of ectocervix were found covered with mature stratified epithelium of uneven thickness with focal thickening with focal basal activity with moderate koilocytosis acanthosis with vascularization dystrophy of individual epithelial cells of the upper and middle layers viral etiology is not excluded flat condyloma of the cervix cannot be excluded

Elena 2019-01-04 20:30:38

if the doctor took a scraping from the cervical canal with a large iron instrument with a round end for histology. There was a condyloma. If you disturb the condyloma like that, it can turn into cancer ... and now what to do .... how to remove the condyloma from the cervical canal

Natalia 2018-12-03 22:38:36

Help me figure it out. Biopsy, the conclusion is a piece of the cervix is ​​lined with stratified squamous epithelium with pronounced cellular and nuclear polymorphism. What's this? Can be cured?

Rosina 2018-11-12 20:10:37

Hello! After conization, the result came, I can’t understand what it means MACRO DESCRIPTION: 3 tissue fragments with a total volume of 1.3 cm3. CONCLUSION: Flat condyloma of the cervix with low-grade intraepithelial neoplasia (CIN 1). Chronic cervicitis with moderate activity, glandular cystic hyperplasia of the endocervix. No signs of intraepithelial neoplasia were detected in the margins of resection of horse biopsies of the cervix. Thank you in advance)

Good afternoon. With this conclusion, you should contact your treating doctor. You will need to remove condyloma and receive treatment with Panavir solution intravenously according to the scheme: for 1,3,5,8,11 days.

Natalia 2018-10-19 10:14:35

Hello. Natalia is 40 years old. I was diagnosed with CIN2 against the background of severe chronic cervicitis with signs of exacerbation, HPV 18 was detected. I would like to know more about this diagnosis and what treatment can be prescribed. I am very worried that I will have to remove the uterus and cervix.

Menshchikova Galina Vladimirovna Dermatovenereologist, dermatooncologist. Candidate medical sciences. Doctor of the first category. Over 15 years experience:

Hello. To increase the effectiveness of treatment of patients with cervical neoplasia associated with papillomavirus infection, it is advisable to conduct complex therapy, including the use of antiviral drug Panavir, before destructive treatment.

It is not uncommon for women undergoing gynecological examinations, including vaginal tests, to be diagnosed with cervical dysplasia by doctors.

The knowledge of most women is reduced to the precancerous nature of the detected deviation. It is not always worth associating dysplasia with oncology, but ignoring such a condition is fraught with serious consequences.

Cervical dysplasia: what is it?

Cervical dysplasia (neoplasia) is the appearance of atypical cells in the cervical integument, consisting of stratified squamous epithelium. Atypicality consists in a change in the shape of the cell, its structure (the appearance of many nuclei or an increase in the size of a single nucleus), the loss of the layered structure of the epithelium covering the neck.

Cells atypical for the structure of this organ begin to reproduce their own kind, thereby replacing healthy epithelium. All these changes occur during cancerous degeneration. However, dysplasia is distinguished from oncology by the only sign - the altered cells do not spread deeper than the basal layer of the epithelium.

Pathological cell mutation occurs at the junction of the cervical mucosa, lined with cylindrical epithelium, and the vaginal part of the uterine cervix, covered with stratified squamous epithelium. Initially, atypical inclusions form in the basal layer of the epithelium, then capture more and more superficial layers.

In this case, not only the correct form of typical cells disappears, but the boundary between the epithelial layers is also blurred. Depending on the layer-by-layer localization of mutated cells, several stages of the development of the disease are distinguished.

Cervical dysplasia grade 1 (CIN 1)

Mild cervical dysplasia involves the detection of altered epithelium only in the deepest layers. Atypical cells are located in the lower third of the epithelium, the basal layer.

Neoplasia Grade 2 (CIN 2)

Moderate dysplasia - the spread of the process of replacing the normal epithelium with altered cells in the thickness of the cervical integument. The defeat of the thickness of the epithelial layers varies in the region of 1/3 - 2/3.

Dysplasia Grade 3 (CIN 3)

Severe cervical dysplasia - called non-invasive cancer, captures all epithelial layers, but does not go beyond the basement membrane.

This classification demonstrates different stages of the formation of atypical lesions on the cervix, which, without proper treatment, eventually leads to oncology. However, the process does not always progress.

Cell mutation is far from a spontaneous process. In order for cells to change their structure and begin to divide randomly, it is necessary to break the protective barrier, which is a complex mechanism for controlling the process of cell division and destroying abnormal elements.

For such a failure, as a rule, the influence of several of the following factors is necessary:

• infection with an oncogenic type of papillomavirus (HPV) is the most common cause of the appearance of atypical cells in the cervical epithelium, the most dangerous types 16 and 18 have a high risk of oncogenicity;
• long-term (more than 5 years) contraception with combined hormonal pills;
• burdened heredity - oncology of the genital organs in blood relatives;
• mucosal trauma - abortion, multiple births;
• immunodeficiency - stress, malnutrition, chronic infections in the body, long-term treatment with antibiotics and corticosteroids;
• frequent or untreated infections of the reproductive system;
• alcohol, smoking active / passive - increase the risk of dysplasia by 4 times.

Women at risk for precancerous neoplasia include:

• who started sexual intercourse at the age of 14-15;
• indiscriminate in the choice of partners;
• large families;
• with a large number of abortions in history;
• leading an asocial life;
• neglecting basic hygiene and condoms.

In women in the post-menopausal period and who have undergone ovarian removal with a doctor-appointed replacement with hormonal drugs, the likelihood of dysplastic pathology does not increase.

Dysplasia of the cervix does not give specific signs. Women often present complaints associated with concomitant inflammation:

• unusual discharge;
• itching and burning sensation in the perineum;
• bloody spotting during intercourse;
• pain, as a rule, is absent and can occur when the delicate mucous membrane of the cervix is ​​traumatized during sexual contact.

Neoplasia does not provoke infertility and does not adversely affect the developing fetus. In addition, hormonal changes during pregnancy cause physiological change cervix, often mistaken for dysplastic processes.

The cylindrical epithelium that moves out of the cervical canal protrudes from the external cervical os in the form of a red corolla (ectropion or pseudo-erosion).

Diagnostics

Pathological changes are detected in the following studies:

• gynecological examination of the uterine cervix in the mirrors - whitish plaques that practically do not change color when stained with Lugol's solution (Schiller testing);
• colposcopy - pale color of the dysplastic focus, increased blood pattern;
• cytology (PAP test) - detection of atypical cells (sensitivity increases with severe neoplasia) and HPV markers
  targeted biopsy and histology of the material taken;
• - Immunological study that detects HPV infection.

Methods and means of treating cervical dysplasia are selected depending on the results of the diagnostic examination.

Since in most cases a slight degeneration of the epithelial layer and the papillomavirus that caused it disappears within 1-2 years, in the treatment of cervical dysplasia of the 1st degree, it is recommended:

• regular monitoring by a gynecologist, including annual cytology and colposcopy;
• complete treatment of inflammation of the vagina;
• replacement of combined oral contraceptives with alternative means;
• elimination of endocrine disorders and strengthening of immunity;
• lifestyle correction - good nutrition, refusal of cigarettes, adequate hygiene.

Treatment of cervical dysplasia grades 2 and 3

Developing neoplasia requires a more radical approach, correction of lifestyle and removal of inflammation in the treatment of cervical dysplasia of 2 and 3 degrees is indispensable, surgery is required.

• Electrocoagulation - removal of atypical cells by cauterization with electric current. The financially available method does not allow you to adjust the depth of exposure. In the healing stage, it often forms rough scars that prevent the opening of the cervix in subsequent births.
• Cryodestruction - freezing of the altered area with liquid nitrogen. Does not leave scars (indicated for the treatment of nulliparous patients), is fraught with a long (up to 1 month or more) fluid leakage.
• Laser coagulation - evaporation of the changed epithelium by means of a laser. To avoid damage to healthy cells, the woman should not move/shudder during the procedure. High efficiency is due to the ability to adjust the depth of exposure.
• Radio wave treatment - removal of cervical dysplasia of 2, 3 degrees due to heating with high-frequency radio waves. Fast recovery, absence of scars and high precision of processing determine the absence of relapses and complications. It is used in nulliparous women. Quite an expensive treatment.
• with dysplasia - surgical excision of the pathological formation. The most traumatic intervention is not recommended for women of childbearing age. If the clinic has special equipment, the removal of neoplasia with a scalpel is replaced by laser excision. This reduces the likelihood of postoperative bleeding and infection, and healing occurs faster.

Mini-traumatic surgeries for cervical dysplasia of the 2nd degree are performed on an outpatient basis, immediately after the end of menstrual bleeding and in most cases do not require general anesthesia.

With any variant of surgical treatment, it is necessary to refrain from sexual intercourse, taking a bath and visiting a sauna / pool, visiting beaches and a solarium. At the end of menstruation after surgery, a gynecological examination is necessary.

Forecast

The prognosis for cervical dysplasia is clearly dependent on the degree of pathology:

• When diagnosing mild neoplasia, only in 1% of cases there is a transition to a moderate and severe degree.
• In patients with identified CIN 2, a severe precancerous form develops only in 16% of cases over 2 years and in 25% over 5 years.
• A severe form of neoplasia (grade 3) turns into invasive cancer (the spread of altered cells beyond the basement membrane) only in 12-32% of patients.

These figures indicate the need for timely detection (preventive examinations) and treatment of the identified pathology. Only the complete lack of attention from the woman herself threatens her with serious consequences.

When diagnosed with grade 3 cervical dysplasia, some women fall into an almost panicky state. It's all about the rumors that accompany this disease in abundance, and promise an almost inevitable oncological pathology.

However, gynecologists warn patients - although dysplasia of such a severe degree belongs to precancerous conditions, She is completely curable..

That is why it is so important to have an idea about the nature of this disease, its pathogenesis, symptoms, and degrees of progression. Early detection of pathology in the initial stages is the key to its successful treatment.

The development of the disease, its causes and symptoms

Dysplasia is the pathological development of the cellular structure of the mucous membrane of the cervix.

Dysplasia pathogenesis

The cervix is ​​the lower part of the organ, consisting of a canal that connects the uterine cavity with the vagina, and the outer, vaginal part. These areas have a completely different cellular structure of the mucous membrane lining them.

The walls of the channel are covered with a single-layer epidermis of cylindrical cells, saturated with mucous glands. The secret secreted by the glands should reliably protect the uterine cavity from infection from the vagina, liquefying only in the middle of the menstrual cycle to skip sperm.

The mucous membrane of the vaginal part of the cervix has a multilayer structure.

1. Inferior, deepest basal-parabasal layer borders on blood vessels, muscle tissue, nerve endings, consists of young cells that multiply in the usual way of division. In the absence of pathology, the cells are round, voluminous, have one large nucleus.
2. During their maturation, cells become central, intermediate layer of the epidermis, while they flatten, the core begins to decrease in size.
3. During further development cells move to outer, functional layer of the mucosa, they should have a pronounced flat structure, a small cell nucleus. As they are replaced, obsolete cells are torn away from the mucosa and excreted from the body naturally.

Degrees of development of dysplasia

Cervical dysplasia is associated with an atypical development of the cellular structure of the epidermis, a violation of the normal size and shape of cells, their hyperchromia, the presence of an abnormally sized nucleus, or even several nuclei.

According to the classification introduced in the 90s of the last century by the World Health Organization, according to the degree of distribution and localization of the pathology, the disease is divided into 3 degrees:

Cervical dysplasia grade 1 (CIN I)- the initial and most common form. At this stage of the disease, atypical processes develop only in the lower, basal layer, without spreading to the intermediate and to the tissues under the basement membrane.

Cervical dysplasia grade 2 (CIN II)- the process covers up to two thirds of the mucosal thickness, while structural cellular changes are more pronounced. At this stage, a violation of the polarity of the arrangement of the layers of the epidermis is often noted.

Cervical dysplasia grade 3 (CIN III)- pathological changes cover almost the entire mucosa, a clear division into layers disappears, all cell formations have pronounced signs of atypicality, often similar to oncological ones. Failure to take timely measures increases the likelihood of malignant neoplasms. By the way, in some sources you can sometimes find quite frank terminology - non-invasive cancer. The spread of pathological processes does not penetrate into the tissues and blood vessels separated by the basement membrane.

Sometimes cervical dysplasia is mistakenly called erosion, although the difference is obvious. Erosion implies a local violation of the integrity of the mucosa due to mechanical damage, chemical burns, infectious lesions. With dysplasia, a deep biological transformation of the cellular structures of the tissue occurs, caused by a number of factors.

Possible causes of hyperplasia, risk groups

• In almost 90% of cases of diagnosing cervical dysplasia, its appearance is associated with the presence in the body human papillomavirus(HPV), which may not manifest itself for the time being. This virus is freely spread sexually, the risks of contracting it are very high - up to 80%. Sometimes infection leads to the formation of genital warts - a clear sign of a viral attack, but this does not happen often. In the "sleeping" form, the virus is very difficult to identify, but, as a rule, its presence in the mucosa for one to two years leads to the development of hyperplasia in an initial, mild degree.
• herpes virus- no less common, and can also be the cause of the onset of pathological processes in the mucosa.
• The motivating reason for the occurrence of cervical hyperplasia of the 1st degree can be genital infections and sexually transmitted diseases.
• The onset of the development of the disease may be associated with endogenous (internal) factors and characteristics of the organism - immune deficiency, impaired activity of the internal secretion organs, hormonal disruptions.

In addition to the immediate causes of the disease, there are certain risk factors that contribute to its appearance and development:

1. The disease is often detected in women who have given birth many times.
2. Deficiency of vitamin products in the daily diet (especially the lack of vitamins A, C and beta-carotene).
3. Too long (5 years or more) continuous use hormonal contraceptives.
4. Early onset of sexual activity (up to 16 years).
5. Frequent change of sexual partners, unprotected sex.
6. Burdened heredity, genetic predisposition to the disease.
7. Exposure to nicotine from both active and passive smoking.
8. Low level of socialization, neglect of elementary hygiene rules, indifference to the state of one's own health.

Importance of early diagnosis and preventive measures

The insidiousness of this disease is that, most often, its onset and progression are not accompanied by any painful symptoms. Unpleasant sensations, discharge, bleeding can be caused, rather, by genital infectious lesions that develop against the background of dysplasia.

That is why gynecologists do not get tired to convince that Every woman should have regular check-ups. Modern methods diagnostics make it possible to identify the onset of pathological processes, which makes it possible to take measures to cure the disease at an early stage.

• In addition to visual examination, gynecologists use colposcopy, which allows you to more clearly identify the foci of the development of pathology, to conduct the necessary diagnostic tests.
• The main diagnostic method is tissue cytology taken with a Pap smear. This procedure is painless, and gives a detailed clinical picture of the state of the mucosal epidermis.
• If necessary, when obvious signs dysplasia, conduct deeper histological examination of tissue samples taken during a biopsy of the cervix.

Although cervical dysplasia is a precancerous condition, you should not panic and give up when making such a diagnosis. Modern medicine has methods for successfully combating this disease, both conservative and surgical, in most cases leading to a complete cure.

In addition, medical statistics say that the risk of transforming the disease into cancer is not as high as it is often presented:

• Over 70% of women with mild to moderate dysplasia get rid of it completely. The disease has the property of regression, of course, when proper preventive and healing procedures are performed.
• The average risk of the transition of the disease from 1 to 2 and 3 degrees, with timely treatment, does not exceed 1%.
• If, nevertheless, the disease has passed into a moderate stage, then cervical dysplasia of the 3rd degree in a five-year period can develop in 25% of patients.
• The development of a cancerous tumor from CIN III is observed in no more than a third of women with dysplasia.

Prevention

To significantly reduce the likelihood of developing cervical dysplasia, for its successful treatment, a systematic (at least once a year) visit to a gynecologist with laboratory tests is required.

And, of course, a woman should carefully analyze her lifestyle, try to change it in order to minimize the potential impact of risk factors.

Video: About cervical dysplasia with Malysheva